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How Regional Health Plans Can Reclaim 80% of Their Risk Scoring Costs

The risk adjustment software market has a dirty secret: most organizations are paying enterprise prices for what is, at its core, a calculator. CMS-HCC scoring logic isn’t proprietary—but vendors have turned it into a six-figure recurring revenue stream. For regional health plans and ACOs under pressure to reduce costs, this trap is draining resources that could be used to improve patient care and outcomes.

The True Cost of Vendor Lock-In

On the surface, vendor-provided risk scoring tools seem convenient. But once you unpack the line items, the total tells a different story:

  • Annual licenses: typically $50K–$100K
  • PMPM fees: $2–$5 per member for larger populations
  • Implementation & training: another $25K–$50K
  • Annual support: typically 15–20% of license fees
  • Integration work: custom development to connect with EHR and claims systems
Typical annual spend
$150K+
For a regional health plan—before the hidden cost of dependency.

And that’s before you factor in the strategic cost of letting a vendor dictate your risk analytics roadmap.

The Vendor Dependency Tax

The dollars tell only half the story. Vendor lock-in creates a drag on innovation and flexibility:

Negotiation power disappears once a vendor is embedded in your workflows.
Customization costs pile up every time you need a new report.
Scaling becomes a penalty with PMPM models that increase as you grow.
Roadmaps dictate progress, leaving your IT and analytics teams waiting on vendor timelines.

What starts as a software contract becomes a dependency that limits your ability to operate efficiently.

The Independence Alternative

Forward-thinking health plans are finding they can cut risk scoring costs by 80%—while gaining more control—by running CMS-HCC models in-house. Tools like MSCORE® make this shift possible with a lightweight, Python-based platform.

The math is compelling:

  • Team license: $2,499 annually (up to 5 users).
  • No PMPM fees: cost stays flat no matter your population size.
  • No implementation costs: live in days, not months.
  • Full feature set included: no add-on pricing or hidden fees.
Compared to a $150K vendor contract
80% Lower Cost
$150K → $2,499 per year
Immediate annual savings: $147K

For an organization currently spending $150K annually on vendor solutions, that’s an immediate savings of $147K every year—while gaining full control over how and where risk scoring runs.

Beyond Cost: Strategic Independence

The real advantage isn’t just savings—it’s independence. When you own your risk scoring infrastructure:

You innovate at your pace, not your vendor’s.
Your analytical capabilities become differentiators, not commodities.
You gain operational resilience without relying on external SLAs.
Your IT team maintains full security control over PHI.

This independence transforms risk adjustment from a costly line item into a strategic capability.

Making the Switch Is Easier Than You Think

Adopting in-house risk scoring doesn’t require ripping and replacing. Python-based tools like MSCORE® can run alongside existing systems during transition, allowing your teams to validate outputs and build confidence before going live. Within days, you can operate a fully independent risk scoring infrastructure—at a fraction of the cost.

The Bottom Line

Health plans and ACOs can’t afford to keep paying enterprise prices for commodity calculations. Vendor lock-in drains budgets, slows innovation, and exposes PHI to unnecessary risk. By moving to local, transparent risk scoring, regional health plans can save hundreds of thousands annually while building long-term competitive advantage.

Calculate your potential savings and explore vendor-independent risk scoring at riskadjustmentmodel.com